Björn Gunterberg

Chordoma: A Clinicopathologic and Prognostic Study of a Swedish National Series

Chordoma is a rare tumor with slow growth developing from remnants of the notochord and thus appears in close relation to the axial skeleton. A Swedish national series collected over a period of 13 years, comprising 51 patients with a follow-up time of 8-20 years, was studied. Histologically all tumors had a typical appearance except two, which had characteristics of chondroid chordoma. Fifty-seven per cent of the tumors were located in the sacrococcygeal region, 27 per cent in the spheno-occipital region and 16 per cent in the vertebrae. The peak age incidence was in the 6th and 7th decades. Male: female ratio was 1:1. The main symptoms were pain and neurologic disturbances. Skeletal destruction was noted radiographically in most instances. Intratumoral calcifications were rarely seen. The treatment was surgery, radiotherapy or a combination of these. There was only one long-term survivor without evidence of disease, a patient operated on for cervical chordoma 14 years earlier. Six other patients lived 8-18 years after diagnosis with chordoma. All other patients were dead; 39 died of chordoma, five of unrelated causes. Distant metastases were noted in 29 per cent. Chordoma constituted 17.5 per cent of all primary malignant bone tumors of the axial skeleton. The yearly incidence was 0.51 per million inhabitants in Sweden.

Favourable results of acrylic cementation for giant cell tumors

A consecutive series from two university hospitals of 50 patients with giant cell tumors was reviewed and histologically reconfirmed. The patients treated with curettage and acrylic cement were re-examined concerning function. Two of 14 cemented tumors had recurred but could be treated by additional cementation, so that no final failure of this method had occurred, compared to one of 19 radically resected and 12 of 22 with bone-graft after curettage. Joint function was normal in 11 and radiographic arthrosis of low grade was found in only two of 14 patients. It is concluded that this method gives a minimum of recurrence and a maximum of function. It is suggested that the old name of giant cell sarcoma should be reintroduced, bringing the tumor into the group of low-grade sarcomas where it belongs.

Osseointegrated trans-femoral amputation prostheses: Prospective results of general and condition-specific quality of life in 18 patients at 2-year follow-up

This is the first report on prospective outcome for individuals treated with bone-anchored trans-femoral amputation prostheses (OI-prostheses) using the method of osseointegration. The aim was to analyze general and condition-specific health related quality of life (HRQL) at 2-year follow-up as compared to the preoperative situation. The study population consists of the first 18 consecutively treated patients (8 male/10 female, mean age 45 years) in a clinical investigation with amputations mainly caused by trauma and tumour. At inclusion the mean time since the amputation was 15 years (10 months – 33 years). Two self-report questionnaires were answered preoperatively and at follow-up: the SF-36 Health Survey (SF-36) and the Questionnaire for persons with a Transfemoral Amputation (Q-TFA). At follow-up 17/18 patients used the OI-prosthesis; one did not due to pain and loosening of the implant. Four of the scales of the SF-36 (Physical Functioning, Role Functioning Physical, Bodily Pain and Physical Component Score) and all four scores of Q-TFA (Prosthetic Use, Prosthetic Mobility, Problems and Global Health) were statistically significantly improved at follow-up showing superior general physical HRQL, increased prosthetic use, better prosthetic mobility, fewer problems and a better global amputation situation. Thus, osseointegrated prostheses represent a promising development in the rehabilitation of individuals with transfemoral amputation and increase their quality of life.

A novel osseointegrated percutaneous prosthetic system for the treatment of patients with transfemoral amputation: A prospective study of 51 patients

Patients with transfemoral amputation (TFA) often experience problems related to the use of socket-suspended prostheses. The clinical development of osseointegrated percutaneous prostheses for patients with a TFA started in 1990, based on the long-term successful results of osseointegrated dental implants. Between 1999 and 2007, 51 patients with 55 TFAs were consecutively enrolled in a prospective, single-centre non-randomised study and followed for two years. The indication for amputation was trauma in 33 patients (65%) and tumour in 12 (24%). A two-stage surgical procedure was used to introduce a percutaneous implant to which an external amputation prosthesis was attached. The assessment of outcome included the use of two self-report questionnaires, the Questionnaire for Persons with a Transfemoral Amputation (Q-TFA) and the Short-Form (SF)-36. The cumulative survival at two years follow-up was 92%. The Q-TFA showed improved prosthetic use, mobility, global situation and fewer problems (all p < 0.001). The physical function SF-36 scores were also improved (p < 0.001). Superficial infection was the most frequent complication, occurring 41 times in 28 patients (rate of infection 54.9%). Most were treated effectively with oral antibiotics. The implant was removed in four patients because of loosening (three aseptic, one infection). Osseointegrated percutaneous implants constitute a novel form of treatment for patients with TFA. The high cumulative survival rate at two years (92%) combined with enhanced prosthetic use and mobility, fewer problems and improved quality of life, supports the revolutionary change that patients with TFA have reported following treatment with osseointegrated percutaneous prostheses.

Desmoid tumors: A clinical review of 30 patients with more than 20 years' follow-up

We retrospectively studied the outcome in a consecutive series of 30 patients with desmoid tumors who were followed for more than 20 years after treatment (surgery in 29 patients). A local recurrence occurred in 12 patients and more than 1 recurrence occurred in 8. 3 patients had spontaneous complete regression of the tumor. At follow-up after mean 28 (20-54) years, all patients were tumor-free except 1 who had had a stable tumor for at least 11 years. Symptoms were related more to treatment than to the tumor. We conclude that desmoid tumors may have a high capacity for self-limitation and that conservative therapy should be considered in symptom-free patients.

Fixation of Pelvic Fractures and Dislocations: An Experimental Study on the Loading of Pelvic Fractures and Sacro-Iliac Dislocations after External Compression Fixation

A trapezoid external compression fixation frame, assembled with the Hoffman instruments, was used for stabilizing experimental injuries to the pelvic skeleton of ten cadaver specimens. The resistance to loading in a position corresponding to upright standing was tested in 17 experiments and related to the calculated load in vivo. The results indicated that ipsilateral injuries, either presenting as dislocations of the sacro-iliac joint and symphysis or as unilateral fractures of the sacrum or ilium in combination with fractures of the pubic rami could be stabilized by the external compression frame well enough to permit weight-bearing in the upright standing position. Bilateral injuries to the pelvic skeleton, vertical or oblique, could not, however, be stabilized enough to resist more than a fraction of the normal load in the upright standing position.

Intraosseous lipoma. A report of two cases.

Intraosseous lipoma seems to be a rare condition as only some 20 cases have been reported so far. A further two cases are described the lesions being in the calcaneus and in the tibia. Radiographically the lesions appeared osteolytic and well delineated, containing calcified areas. The microscopic features were those of mature adipose tissue. Curettage and packing with autogenous bone grafts is recommended, if the lesion causes pain or a correct diagnosis cannot otherwise be obtained.

Fine‐needle aspiration characteristics of hibernoma

Hibernoma is a rare, benign lipomatous tumor with features of brown fat. The preoperative diagnosis of hibernoma is difficult at times because its clinical, radiographic, and fine‐needle aspiration (FNA) characteristics overlap with those of liposarcoma.

Resurfacing arthroplasty of the hip

SummaryAs an alternative in total hip replacement the so called resurfacing arthroplasty of the hip is gaining wider acceptance. The procedure can be said to be a modernisation of the original Smith-Pedersen operation and is suggested in young people with degenerative hip disease, congenital hip dysplasia or Perthes disease. The advantages are that the femoral head and neck are retained and thus no femoral stem prosthesis is necessary. The greatest disadvantage is that in case of socket loosening a secondary operation might not remain as successful as could the initial operation with a socket which is not as large as those recommended for the resurfacing procedure.In this presentation a preliminary report of a one-year material is presented together with a presentation of advantages, disadvantages, and the biomechanical appraisal of resurfacing of the hip. Fifteen patients with 17 hips have been operated and followed-up and by using the Merle dAubigne evaluation there was an improvement of some 3–4 points in pain, walking, and total motion. Patient opinion indicated 80% satisfaction. The management of two serious complications is also described.

Function After Anterolateral Resection of the Lower Leg for Extirpation of Tumors: Extension and Pronation of the Foot Restored by Transfer of the Tibialis Posterior Muscle

A function preserving method for radical removal of tumors located anterolaterally in the lower leg is described. The loss caused by the inclusion of all extensors and pronators of the foot in the surgical specimen is compensated for, to a large extent, by transfer of the tendon of the tibialis posterior muscle to the conjoint tendons of the extensor digitorum longus and peroneus tertius. The function after such an operation has been studied in two patients using various methods including strength measurements and, in one of them, electromyography.